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KMID : 0371319740160060047
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Journal of the Korean Surgical Society
1974 Volume.16 No. 6 p.47 ~ p.52
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Spontaneous Enterobiliary Fistula
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金聖哲/Kim, Sung Chul
張瑄澤/Chang, Sun Taik
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Abstract
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Spontaneous enterobiliary fistula is very rare and the majority of patients with this condition are in the older age group. Spontaneous enterobiliary fistula is produced most frequently by chronic diseases of biliary tract associated with gall stone, followed by peptic ulcer and by malignancy or trauma. The vast majority of spontaneous enterobiliary fistulas result from adherence of the inflammed gall bladder or common bile duct to adjacent viscus and. erosion of a gall stone into the adherent organ.
Spontaneous enterobiliary fistula is usually difficult to diagnose preoperatively, and the condition is unexpectedly encountered in the operating -room.
Spontaneous enterobiliary fistulas may be classified in order of descending frequency: cholecystoduodenal, cholecystocolic, cholecystogastric, choledochoduodenal and cholecystocholedochal. This last type of fistula is rare indeed. Complications of spontaneous enterobiliary fistula include gall stone ileus, ascending cholangitis, severe diarrhea in cases of cholecystocolic fistula, and gastrointestinal hemorrhage. The management of patients with spontaneous -enterobiliary fistulas is usually complex and often controversial.
Our experience with 5 cases of spontaneous enterobiliary fistula during 6 years period from June, 1968 through April, 1974 in the Department of Surgery, Sacred Heart Hospital, Chung Ang University, College of Medicine is reported herein.
There were four female and one male patients whose ages ranged from forty-one to seventy four years.
Of the 5 cases, 3 fistulae were cholecystoduodenal, one was choledochoduodenal, and one was cholecystoduodenal and cholecystocolic. Correct diagnosis was made in 3 cases preoperatively by X-ray. Of the 5 patients, two did not undergo operation because of senility or refusal to recommended operation. The remaining three underwent operation. Two had a cholecystectomy, choledochostomy and repair of fistula, and one patient had a cholecystectomy, repair of fistula, subtotal gastrectomy and gastrojejunostomy to control duodenal ulcer disease which was the cause of the fistula.
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